Also referred to Colorectal Cancer or cancer of the large bowel.

The areas affected are: Colon, Rectum, and Appendix.

Deaths related to colon cancer are above 650,000 per year worldwide

It is the fifth most common form of cancer in the U.S.

Colon Cancer in the bowel begins from polyps referred to as Adenomatous polyps.

Polyps appear as mushroom-shaped and are usually non-cancerous [benign]

Colonoscopy is usually the mode of diagnosis

Symptoms:

-  Abdominal pain
-  Constipation
-  Diarrhea
-  Smaller stools
-  Blood in stool – bright red
-  Black stools – older blood
-  Increased mucus in stool
-  Vomiting
-  Abdominal Distension
-  Lack of iron – anemia
-  Loss of weight
-  Loss of appetite

Risk Factors:

- 7% risk of getting colon cancer within your life

1.)  Age – Occurs more often in 60s and 70s
2.)  Diet
3.)  Smoking
4.)  Physical inactivity or low activity
5.)  History of cancer
6.)  Genetics
   -  Family History of colon cancer  – especially when cancer occurs in the
family member under the age of 55
-  Familial adenomatous polyposis  -  nearly a 100% chance if untreated

7.)  Polyps
8.)  Virus
   -  Human Papilloma Virus [HPV]

9.)  Alcohol – may be a risk factor in heavy doses
10.)  Environmental factors
11.)  Exogenous hormones – [though little evidence]

Causes:

Cancer starts in the epithelial cells of the colon or rectum
Mutations are often seen of the Wnt signaling pathway
Many different proteins may have a mutation
Some mutations are inherited while some are acquired
Often takes years for colon cancer to progress
Earlier the diagnosis the better the prognosis

Staging

Stage 0  -  Tumor only in mucosa [Cancer-in-situ]

Stage 1 –

T1:  Tumor enters submucosa
T2:  Tumor enters muscularis propria

Stage II-A  Tumor enters subserosa or deeper, no organs involved

Stage II-B  Tumor enters adjacent organs

Stage III-A  Tumor and metastasis to 1-3 regional lymph nodes

Stage III-B  Tumor and metastasis to 4 or more regional lymph nodes

Stage III-C  Tumor and distant metastasis present

Diagnosis

Digital Rectal Exam
Fecal Occult Blood Test
Sigmoidoscopy – Flex Sig
Colonoscopy
Blood work

.  Carcinoembyronic antigen[CEA] is a protein found in most all colorectal tumors.

Standard Computed Axil Tomography
Virtual Colonoscopy
Barium enema

Prevention

Early awareness

Colonoscopy by age 50 unless family history

Repeat Colonoscopy every 5 – 10 years if normal

Abnormal colonoscopy will change the follow up visit

Lifestyle and Nutrition

-  Limit: overeating, sedentary and high red or process meats

-  Increase:  physical fitness, good nutrition, dietary fiber

Calcium

-  May or may not provide some degree of prevention

Aspirin

-  Should not be taken to prevent Colorectal cancer

Treatment

Surgery

-  In early stages surgery is curative
-  Removal of polyps during colonoscopy
-  Surgical removal of section of colon affected
-  Removal of regional lymph nodes may be necessary

Chemotherapy

-  May be applied after surgery
-  May be the only form of treatment in certain cases

.     Cetuximab  (Erbitux)
.     Panitumumab  (Vectibix)
.     5-fluorouracil  (5-fu)
.     Capecitabine  (Xeloda)
.     Leucovorin   (LV, Folinic Acid)
.     Oxaliplatin  (Eloxatin)
.     others

Radiation

Not often used

Can lead to “radiation enteritis”

Can be used more in rectal cancer

Palliative treatment

*** – non currative

Investigated Treatments

Cancer Vaccine – TroVax

Immunotherapy 0  Bacillus Calmette-Guerin

Chemotherapy